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Supraventricular Rhythms: Difference between revisions
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{{authors| | |||
|mainauthor= [[user:Drj|J.S.S.G. de Jong]] | |||
|moderator= [[user:Drj|J.S.S.G. de jong]] | |||
|supervisor= | |||
}} | |||
===Supraventricular tachycardias=== | |||
{| class="wikitable" border="1" width="610px" | |||
|- | |||
| [[Image:atrial_ventricular.png|300px]] | |||
| [[image:SVT_overview.svg|300px]] | |||
| [[Image:Svt_algorythm_en.png|300px]] | |||
|- | |||
!Arrhythmias are categorized into supraventricular and ventricular depending on their origin (below the bifurcation of the His bundle is ventricular) | |||
!An overview of pathological supraventricular arrhythmias and their origin | |||
!Algorithm to diagnose SVTs<cite>ACC</cite> | |||
|} | |||
{| class="wikitable" font-size="90%" | |||
|- style="text-align:center;background-color:#6EB4EB;" | |||
|+'''An overview of supraventricular tachycardias''' | |||
|- | |||
! | |||
!Example (lead II) | |||
!Regularity | |||
!Atrial frequency | |||
!Ventricular frequency | |||
!Origin (SVT/VT) | |||
!P-wave | |||
![[Effect of adenosine]] | |||
|- | |||
| colspan="8" style="text-align:left;background-color:#cfefcf;" | '''Narrow complex (QRS<0.12)''' | |||
|- | |||
! [[Sinustachycardia]] | |||
| [[Image:sinustachy_small.svg|200px|Sinustachycardia - a normal p wave precedes every QRS complex]] | |||
| regular | |||
| 100-180 bpm | |||
| 100-180 bpm | |||
| sinusnode (SVT) | |||
| precedes every QRS complex | |||
| gradual slowing | |||
|- | |||
! [[Atrial Fibrillation]] | |||
| [[Image:afib_small.svg|200px|Atrial fibrillation - irregular rate, no p waves]] | |||
| grossly irregular | |||
| 400-600 bpm | |||
| 75-175 bpm | |||
| atria (SVT) | |||
| absent | |||
| slows down rate; irregularity remains | |||
|- | |||
! [[Atrial Flutter]] | |||
| [[Image:aflutt_small.svg|200px|Atrial flutter - sawtooth in lead II with 2:1 block]] | |||
| regular (sometimes alternating block) | |||
| 250-350 bpm | |||
| 75-150 bpm (3:1 or 2:1 block is most common) | |||
| atria (SVT) | |||
| negative sawtooth in lead II | |||
| temporary reduced conduction (e.g. 4:1) | |||
|- | |||
! [[AVNRT]] | |||
| [[Image:avnrt_small.svg|200px|ANVRT - rSR' in lead V1]] | |||
| regular | |||
| 180-250 bpm | |||
| 180-250 bpm | |||
| AV-node (SVT) | |||
| in QRS complex (R') | |||
| stops | |||
|- | |||
! [[Atrial Tachycardia]] | |||
| [[Image:atrialtachy_small.svg|200px|Atrial tachycardia - like sinustachycardia but the p wave has a different morphology]] | |||
| regular | |||
| 120-250 bpm | |||
| 75-200 bpm | |||
| atria | |||
| precedes QRS, p wave differs from sinus-p | |||
| temporary AV-block | |||
|- | |||
! [[AVRT|Atrio-Ventricular Reentry Tachycardia (AVRT)- orthodromic]] | |||
| [[Image:avrt_small.svg|200px|AVRT - inverted p wave behind every QRS complex]] | |||
| regular | |||
| 150-250 bpm | |||
| 150-250 bpm | |||
| circle: av-node - ventricles - bypass - atria | |||
| RP < PR | |||
| stops | |||
|- | |||
! [[AVJT|AV junctional tachycardia]] | |||
| [[Image:avnodal_small.svg|200px|AV junctional tachycardia - no or inverted p-waves within QRS complex]] | |||
| regular | |||
| 60-100 bpm | |||
| 70-130 bpm | |||
| AV node | |||
| RP < PR | |||
| reduces rate | |||
|- | |||
| colspan="8" style="text-align:left;background-color:#cfefcf;" | '''Wide complex (QRS>0.12)''' | |||
|- | |||
! [[Supraventricular tachycardia with block]] | |||
| [[Image:atrial_tachy_with_LBBB_leadII.svg|200px|SVT with block - any SVT combined with LBBB or RBBB]] | |||
| (ir)regular depending on SVT | |||
| 100-250 bpm | |||
| 75-200 bpm | |||
| atria (SVT) | |||
| absent | |||
| temporary increased AV-block (eg 4:1) | |||
|- | |||
! [[AVRT|Atrio-ventricular Reentry Tachycardia (AVRT) - antidrome]] | |||
| | |||
| regular | |||
| 150-250 bpm | |||
| 150-250 bpm | |||
| circular: bypass - atria - av-node - ventricles | |||
| RP < PR | |||
| stops | |||
|- | |||
|} | |||
{{Box| | |||
===Supraventricular [[Ectopic Beats|ectopic beats]]=== | |||
*[[Atrial Premature Complexes]] | |||
*[[Wandering Pacemaker]] | |||
*[[AV-nodal complexes]] | |||
}} | |||
{{Box| | |||
===Also read=== | |||
*[[Introduction to Arrhythmias]] | |||
*[[Mechanisms of Arrhythmias]] | |||
*[[Sinus node rhythms and arrhythmias]] | |||
*[[Junctional Tachycardias]] | |||
*[[Ventricular Arrhythmias]] | |||
}} | |||
{{Box| | |||
==References== | |||
<biblio> | |||
#ACC pmid=14563598 | |||
</biblio> | |||
}} | |||
[[Category:ECG Textbook]] | |||